Osservatorio Permanente sui Giovani e l’Alcool QUADERNI DELL’OSSERVATORIO 19 Italy and Alcohol: a country profile Allaman Allamani Centro Alcologico dell’Azienda Sanitaria di Firenze Simona Anav Osservatorio Permanente sui Giovani e l’Alcool, Roma Francesco Cipriani Osservatorio di Epidemiologia, Agenzia Regionale di Sanità, Firenze Daniele Rossi Federalimentare Fabio Voller Osservatorio di Epidemiologia, Agenzia Regionale di Sanità, Firenze OSSERVATORIO PERMANENTE SUI GIOVANI E L’ALCOOL PRESIDENTE Umberto Veronesi VICE PRESIDENTI Stefano Zurrida - Giancarlo Trentini SEGRETARIO GENERALE Michele Contel PRESIDENTE LABORATORIO SCIENTIFICO Enrico Tempesta LABORATORIO SCIENTIFICO Pierluigi Ascani – Format Research Roma Andrea Balbi – ASL Roma D Franca Beccaria – Eclectica Torino Lamberto Briziarelli – CSESI Perugia Carlo Caltagirone – Fondazione Santa Lucia Roma Paola Carbone – Università LA Sapienza Roma Maurizio Fea – Federserd Pavia Gilberto Gerra – Narcotics Board Control ONU Vienna Andrea Ghiselli - INRAN Roma Ina Hinnenthal – SERT NOA Imperia Fabio Mariani- CNR Pisa Luca Pagliari – RAI Franco Prina – Università Torino Daniele Rossi – Federalimentare Roma Ennio Salamon – Doxa Milano Natascia Sporn – GPF Milano COMITATO SCIENTIFICO DEI GARANTI Luigi Bazzoli Amedeo Cottino Valeria Del Balzo Maurizio De Tilla M. Antonia Modolo COORDINAMENTO ATTIVITÀ Simona Anav SOCI FONDATORI Associazione Industriali Birra e Malto Confederazione Italiana Vite e Vino-Unione Italiana Vini Fondazione Cesar Università di Perugia Copyright ® 2007 Osservatorio Permanente sui Giovani e l’Alcool E’ vietata la riproduzione, anche parziale, ad uso interno o didattico, con qualsiasi mezzo, se non autorizzata. Osservatorio Permanente sui Giovani e l’Alcool Viale di Val Fiorita, 90 - I - 00144 Roma Tel. +39.06.60 50 77 41 - 06.54 39 32 15 - Fax +39.06.59 12 910 e-mail: [email protected] - web: www.alcol.net CONTENTS INTRODUCTION (Harold Holder) pag. 5 1. Alcohol and culture: Southern Europe (Allaman Allamani ) pag. 7 2. THE COUNTRY (Fabio Voller – Francesco Cipriani) pag. 17 3. ALCOHOL PRODUCTION (Daniele Rossi – Simona Anav) pag. 25 4. ALCOHOL CONSUMPTION (Fabio Voller – Francesco Cipriani) pag. 31 5. DRINKING PATTERNS (Allaman Allamani) pag. 42 6. ALCOHOL RELATED MORTALITY (Fabio Voller – Francesco Cipriani) pag. 48 7. ALCOHOL ECONOMY AND DISECONOMY (Daniele Rossi) pag. 52 8. ALCOHOL POLICIES (Allaman Allamani) pag. 57 9. ITALIAN LAWS, ADVERTISING AND DRUNK DRIVING (Simona Anav) pag. 66 10. TAXES AND LICENSING (Simona Anav) pag. 75 11. PREVENTION (Allaman Allamani) pag. 81 12. THE TREATMENT SYSTEM (Allaman Allamani) pag. 93 Analytical index pag. 108 INTRODUCTION Italy is a country of rich tradition and heritage. A part of this heritage has been the role of alcohol and drinking in the life of its people. Any vis- itor travelling through Italy can not help but be aware of the many grape vineyards which dot the countryside. Alcohol, especially wine, has been present in Italy from ancient times. This country profile about Italy is an extremely welcomed and rich source of recent information about this country and its relationship to alcohol and its consumption as noted in the profile, Italy, like most mem- ber countries of the European Union has undergone significant cultural and economic changes. With this transformation has come change in the role and use of alcohol, especially wine. One of the changes has been a reduction in the total per capita consumption of absolute alcohol. Other changes have occurred in the ways in which alcohol is used, and in the increased risk from alcohol impairment on the roadways of Italy. There has also occurred a 50% decline in the amount of land set aside for grape cultivation. This publication provides a comprehensive summary of key topics including production, total consumption of alcohol, patterns of consump- tion, alcohol-related mortality, alcohol-related policies and norms, eco- nomic aspects of alcohol as well as discussions on taxes and licensing for alcohol distribution outlets. It concludes with discussions of patterns and opportunities for prevention of alcohol-involved harm and the treatment of alcohol-dependent persons. 5 The authors of this profile have assembled a valuable collection. It is organized in a way so as to take the reader through a complete journey in the Italian alcohol-related history, economics, drinking, and policies. It is also an excellent reference source. Organized in concise chapters, the reader can pick and choose those sections most relevant to his/her individ- ual interests and needs. Harold D. Holder, Ph.D. Prevention Research Center Pacific Institute for Research and Evaluation Berkeley, California USA 6 1. ALCOHOL AND CULTURE: ITALYAND SOUTHERN EUROPE (Allaman Allamani) Italy and the southern, or Mediterranean, European countries are soci- eties typically based on time-honoured strong family ties and a rural tra- dition that only during the last decades underwent a process of change in the context of industrialisation and urbanisation characterising the post- World War II era. Moreover Italy, France, Portugal, and Spain share a common Latin origin of their languages, and Christian Catholicism as the religion most practiced. The Mediterranean European countries are wine producers, and for most of them wine production and marketing are important economical issues. Drinking wine is part of daily life, and both values and patterns related to alcoholic beverages are different than in countries where drink- ing is episodic, as is usual in northern Europe. Also, trends in consump- tion and alcohol-related mortality, as well as changes in the pattern of drinking show themselves in a way which appears specific to the southern countries and diverse from the northern ones (see Simpura & Karlsson, 2001; Östenberg & Karlsson, 2002) . Even if such a generalisation is arguable, nevertheless we believe that it has an explanatory power when considering drinking values and pat- terns, changes in consumption and prevention policies. 1.1. Consumption Patterns and Values Attributed to the Alcohol Beverages According to a number of studies, the European territory has been divided up into two large European regions. Such a distinction has been blurred by the changes in drinking patterns in the last decades, but it still is in use (Cottino 1991, Room 1992, Heath 1995, Allamani, Voller, et. al. 2000): 7 (a) the northern “dry” area, – as Sweden, Finland, and Norway where spirits and beer are the leading beverages, consumed on weekends and outside mealtimes; (b) the southern, or Mediterranean “wet” area, – France Italy, Spain, Portugal, and Greece – where by and large wine is the main bev- erage, usually drunk at meals. In the northern countries, alcohol is experienced as a psychotropic substance consumed to perform a number of actions, according to a Bacchic and heroic approach, or for satisfying hedonistic needs. Since it is experienced as elating the self, it has been used as an instrument to over- come stress, or to prove one’s manliness. It is felt as a means to perceive “having a lack of control” or transgression. Typically drinking is concen- trated on relatively rare occasions with high intake per session (Simpura & Karlsson, 2001). In the southern countries, wine is drunk for its taste and fragrance, often during daily meals within the family and other social contexts with a relatively regular weekly consumption. It is considered to be a food item. Drinking wine is sociable per se, so that people need not drink because they want to be sociable through the chemical effects of alcohol. Usually drinking does not appeal to the topic of control and does not elicit any image of either achievement or performance. In fact, southern Europeans do not equate alcohol with wine, but rather with spirits, while they may identify beer with soft drinks. Wine is a product of the vineyard. Vineyards are well visible in the countryside, and sometimes cultivated even within one’s garden, and it is perceived as being part of the vegetal realm. Purchasing wine by citizens from a country winery still today recalls the values of nature and creation. Until recent years, in the Southern rural societies the strong extended families and intense community ties served as a consistent model of a tra- ditional drinking pattern, to be transmitted through generations, and worked as an informal social control process towards excessive drinking. However, since the 1970’s the increased urbanisation, industrialisation, migration and tourism have weakened the traditional societal patterns and new attitudes, including new alcohol beverages, have come in from the North. 8 1.2. Changes in the Amount of Consumption and in Drinking Pattern Alcohol consumption remarkably declined in the southern European countries, mainly because of a drastic reduction of wine intake - by more than 50% in the period 1970-2005 both in Italy and in France. In the same period beer consumption had increased, but not as much as to balance the decrease in wine, which by and large still stands as the main alcoholic bev- erage (see Leifman, 2001). On the other hand, during the same period consumption in the north- ern countries as well as in central Europe generally increased especially from the 1970s to the early 1990s. On a whole, the dispersion of alcohol consumption in European countries found in the 1960s started to decline in the following decades. By the beginning of this millennium a conver- gence among the amounts of alcohol intake of the European